Impacted Canines
A tooth is said to be impacted when it fails to emerge through the gums and is ‘stuck.’ This is a common case with wisdom teeth as they are commonly impacted. Wisdom teeth are often stuck in the back of the jaws and can cause damage to adjacent teeth or be a source of infection. Because wisdom teeth are rarely functional, they are usually removed at an early age. The canine tooth or the eye tooth is second most common tooth to become impacted. The canine plays a critical role in your ‘bite.’ Because they are very strong biting teeth and have the longest roots, they are designed to be the first teeth that touch when your jaws close together. They also help guide the rest of your teeth into the proper bite.
The upper canine tooth is the last of your ‘front’ teeth to erupt. They usually come out around the age of 13 and cause any space left between your upper front teeth to close tighter together. When your dentist or orthodontist notices your canine tooth is impacted, every attempt is made to get it to erupt into its proper position in the dental arch. The technique can work both in the upper and lower arch. The impacted canine is usually found on the roof of the mouth or the palatal side of the dental arch. The remaining impacted canines are found above the roots of the adjacent teeth and on the cheek side (facial) of the dental arch.
Early Recognition is the Key to Success
The older the patient is, the less likely an impacted canine is able to erupt into proper position even if there is enough space in the dental arch. The American Association of Orthodontists recommends an examination and screening panoramic x-ray on all patients around the age of 7 to count the teeth and determine if there are any problems with the eruption of adult teeth. Are there extra teeth or some teeth missing? Are all the adult teeth present? Is there crowing or not enough space available? Are there teeth or pathology blocking the eruption of adult teeth? This evaluation is usually performed by your general dentist and you may be referred to your oral surgeon and orthodontist for a further consultation. An orthodontist may place braces in your mouth to open spaces for proper eruption of adult teeth. An oral surgeon may need to remove extra teeth or growths that are impeding the eruption of adult teeth. Early intervention and recognition allow the best chance for proper eruption of adult teeth. Delayed treatment, even as early 13-14, could result in the impacted adult tooth stuck in the jaw and never erupt fully.
What Happens If The Eyetooth Will Not Erupt When Proper Space Is Available?
There are many cases where the canine tooth fails to erupt as previously discussed. They may be stuck in the roof of the mouth or on the cheek side of the dental arch. The orthodontist and oral surgeon often have to work together in these situations to get these impacted canines to erupt.
The most common scenario involves the orthodontist opening up the space to provide room for the impacted tooth. Once space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted canine exposed and bracketed.
Often called ‘expose and bond’, this is a simple surgical procedure performed in the surgeon’s office. The gum around the impacted canine is removed to ‘expose’ the hidden tooth underneath. The oral surgeon will then bond an orthodontic bracket to the exposed tooth and this bracket will have a miniature gold chain attached to it. The surgeon may attach the chain back onto the braces wire.
After surgery, the patient will see the orthodontist who will attach a rubber band to the gold chain. This a light eruptive pulling force on the impacted tooth. The process is a carefully controlled method of moving the tooth into its proper position in the dental arch. Your surgeon will then evaluate the gum tissue around the tooth to make sure it is sufficiently strong and healthy to last for a lifetime. Some situations require ‘gum surgery’ to add more gum tissue over the newly erupted tooth, especially those where the tooth had to be moved a long distance.
What to expect from surgery
The expose and bond surgery is a relatively straightforward procedure that is regularly performed in the oral surgeon’s office. It may be done under local anesthesia, but more commonly under intravenous sedation.
A limited amount of bleeding from the surgical site is expected for the first 24 hours. There may be some discomfort after surgery but usually within 2-3 days, there is little need for medication to manage the pain. You should plan to see your orthodontist within 1-14 days to activate the eruption process with the rubber band. As always your doctor is available at the office or can be beeped after hours if any problems should arise after surgery. Simply call our office at 604 589 7000 if you have any questions.
You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have.
Within two to three days after surgery, there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not a common finding at all after these cases. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site if they jab the wound during initial healing. Your doctor will see you seven to ten days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth.
What To Expect From Surgery To Expose & Bracket An Impacted Tooth?
The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the oral surgeon’s office. For most patients, it is performed with using laughing gas and local anesthesia. In selected cases, it will be performed under IV sedation if the patient desires to be asleep, but this is generally not necessary for this procedure. The procedure is generally scheduled for 75 minutes if one tooth is being exposed and bracketed and 105 minutes if both sides require treatment. If the procedure only requires exposing the tooth with no bracketing, the time required will be shortened by about one half. These issues will be discussed in detail at your preoperative consultation with your doctor.
You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have.
Within two to three days after surgery, there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not a common finding at all after these cases. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items like crackers and chips as they will irritate the surgical site if they jab the wound during initial healing. Your doctor will see you seven to ten days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth. As always at Pacific Coast Oral and Maxillofacial Solutions, your doctor can be beeped after hours if any problems should arise after surgery. Simply call our office at 604 589 7000 if you have any questions.
